Endocrinologic Outcomes of Patients with Pituitary Adenomas

Background: The role of transsphenoidal resection of pituitary adenomas on recovery of preoperative hypopituitarism and the incidence of postoperative hypopituitarism is not well understood. The presence of preoperative deficits has been used to predict postoperative to predict postoperative outcomes following transsphenoidal resection of pituitary adenomas. This study attempts to identify rates of preoperative hormonal deficits and rates of postoperative hormonal levels with postoperative resolution of those deficiencies.

Methods: A retrospective chart review of a 4-year timeframe was performed for 222 consecutive endonasal cranial base surgical procedures. Preoperative variables included age, sex, history of previous pituitary tumor resection, symptom presentation, and tumor size. Preoperative hormonal levels collected included prolactin, IGF-1, FSH, LH, TSH, T4, ACTH, and AM cortisol (Tables 1 and 2). With the exception of AM cortisol which included additional values, hormone values were included only if they were within a timeframe of no more than 6 months prior to the surgical date and no more than 9 months postoperatively.

Results: The mean patient age at surgery was 54.3 years old (range: 15–86) and there were 116 male patients. Of the 222 patients, 41 (18.5%) had a prior resection of a pituitary tumor. Patients presented with symptom duration on average of 31.8 months prior to surgical resection and had an average largest tumor dimension of 2.38 cm. Preoperative clinical presentation of endocrinopathy was identified in 102 patients (45.9%). 75% of cases with low preoperative IGF-1, 69.2% of cases with low FSH, 70% of cases with deficit LH, 61.1% of low TSH cases, 73.9% of T4 cases, and 100% of cases with low preoperative ACTH would resolve postoperatively. Additionally, 89.2% of cases with low AM cortisol resolved postoperatively. New cases of postoperative hormonal deficits were also assessed. Postoperatively 69.6% of patients with low prolactin levels, 76% of patients with low postoperative IGF-1levels, 75% of cases with low FSH levels, 58.6% of low postoperative LH patients, 68.2% of low TSH levels, 62.5% of low T4 levels, and 100% of low ACTH levels developed these complications with no previously recorded deficiency in their hormone level.

Conclusion: One of the main goals of resection of pituitary adenomas is to restore hormonal function of the pituitary gland. While a majority of these patients experience resolution of their preoperative hormonal deficit postoperatively, a marked percentage of individuals with normal levels subsequently develop hormonal deficits. Future studies will need to investigate which preoperative factors will predispose patients to resolving preoperative deficiencies and which predispose patients to developing the deficiencies with no prior history of low levels.

 

MissingLinkText

No conflict of interest has been declared by the author(s).